THAB0204

1. THAB0204 Knowledge, Attitudes, and Practices of HIV Care and Antiretroviral Therapy Among HIV-Infected Adults Attending Private and Public Clinics in India Satish B Vaidya1, Suneil R Ramchandani2, Shruti H Mehta3, Dattatray G Saple4, Ved P Pandey5, Ravi Vadrevu6, Sikhamani Rajasekaran7, Vandana Bhatia8, Abhay Chowdhary8, Robert C Bollinger3,9, and Amita Gupta9. 1. KJ Somaiya Medical College (Mumbai, India); 2. National Naval Medical Center, Bethesda, USA); 3. Johns Hopkins University School of Public Health (Baltimore,USA); 4 G.T Hospital, Grant Medical College (Mumbai, India); 5 M.Y. Hospital (Indore, India); 6 Sai Sudha Hospital (Kakinada, India); 7 Tambaram Sanitorium (Chennai, India) 8 AIDS Research and Control Centre (Mumbai, India); 9 Johns Hopkins School of Medicine (Baltimore, USA)

2. HIV in India • Estimated 5.2 – 5.7 million HIV-seropositive persons • 70% of HIV infected found in high-prevalent states • Approximately 550,000-700,000 Indians currently have AIDS

3. Health Care in India • Public Health Care Sector • Provides primary to tertiary care • Free of cost • Small percentage of all national health care expenditures. • Private Health Care Sector • 70% of Indian patients receive care in the private sector. • Provides fee-for-service care • Largely unregulated • 80% of the national health care expenditure. • Patients receiving Antiretroviral Treatment (ART) predominantly seen in private facilities.

4. Objectives • To understand HIV infected persons’ knowledge, attitudes and practices (KAP) towards ART in public and private clinics in India

5. Methods: Study Design • Feb 2004 – Jul 2004: Cross-sectional survey conducted at 3 public and 3 private clinics/hospitals in India • Mumbai • Public clinic • Private clinic • Chennai • Public Hospital • Kakinada • Private Hospital • Indore • Public Hospital • Private Clinic

6. Methods • Inclusion criteria • HIV-infected and knowledgeable of his/her HIV status • Seeking care at selected study site • ≥ 18 years old • Deemed physically and mentally capable to complete the survey. • Survey Instrument • Administered by trained counselors in face-to-face interview in local language • Questions included: • Sociodemographics • HIV clinical history (including pattern of antiretroviral exposure) • HIV Treatment • Perceptions/knowledge of ART

7. Data Analysis • General characteristics of participants in private vs. public were compared using chi-square tests for categorical variables and Mann-Whitney tests for continuous variables. • Univariate and multiple logistic regression analysis was used to identify factors independently associated with being on antiretroviral therapy.

8. Characteristics of Study Population n=1,667

9. Characteristics of HIV Historyn=1,667

10. Characteristics of HIV Historyn=1,667

11. Access to HIV Care n=1,667

12. ART Knowledge n=604

13. Patients Taking ART n=1,667

14. Patients not taking ART n=830

15. Multivariate Analysis

16. Conclusions • HIV patients cared for in public health care facilities were less likely to be employed and had a decreased income. • Knowledge and access to ART were greater for patients attending private clinics, but overall levels were low in both private and public settings. • Overall Barriers to HIV care and ART use include: • Low awareness of ART • Long travel times to clinic • Financial constraints

17. Conclusions • Factors associated with ART use include: • Obtaining care at a private clinic • Being aware of ART • Completed CD4 test • Factors associated with lack of ART use: • Female gender (trend towards significance) • Longer travel times to health care site.

18. Limitations • Cross-sectional Survey • Sites may not be representative of the broader population of HIV-infected individuals in India • Reflection of specific health-seeking HIV populations • Selected, predominantly urban outpatient clinics in India. • Overestimated levels of knowledge and access to ART. • Some differences may have been driven by individual site differences.

19. Implications • Further educational and programmatic efforts are needed to improve treatment awareness and access for HIV-infected persons in both public and private settings in India. • As India continues to develop its ART programs in the public domain, educational/social program development of the private sector will be equally important.

20. Acknowledgments • We would like to acknowledge the study participants and the staff at the following sites for their contribution with this work: • HHRF and ARCON, Mumbai • Tambaram Sanitorium, Chennai • MY Hospital clinic, Indore • Sai Sudha, Kakinada • Yale University Office of Research • Johns Hopkins Center for Clinical Global Health Education